The impact of social determinants of health on obesity and diabetes disparities among Latino communities in Southern California

Background Social determinants of health (SDoH) describe the complex network of circumstances that impact an individual before birth and across the lifespan. SDoH contextualize factors in a community that are associated with chronic disease risk and certain health disparities. The main objective of this study was to explore the impact of SDoH on the prevalence of obesity and diabetes, and whether these factors explain disparities in these health outcomes among Latinos in Southern California. Methods We utilized three composite indices that encompass different SDoH: the Healthy Places Index (HPI), Social Vulnerability Index (SVI), and CalEnviroScreen (CES). Univariate linear regression models explored the associations between index scores with adult obesity, adult diabetes, and childhood obesity. Results Communities with lower HPI scores were associated with higher prevalence of metabolic disease and a greater proportion of Latino residents. Cities in the lowest decile of HPI scores had 71% of the population identifying as Latino compared to 12% in the highest decile. HPI scores explained 61% of the variability in adult obesity (p < 0.001), 41% of the variability in childhood obesity (p < 0.001), and 47% of the variability in adult diabetes (p < 0.001). Similar results were observed when examining SVI and CES with these health outcomes. Conclusions These results suggest that Latinos in Southern California live in communities with adverse SDoH and face a greater burden of adult obesity, diabetes, and childhood obesity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14868-1.


Supplemental
Childhood Obesity: Calculated using school-reported body composition results from respondents in the 5 th , 7 th , and 9 th grades This table presents the source documentation and description of the ten adult and the single child health outcomes analyzed.  considered in this analysis. The y-axis represents the CES Score percentile, with 0 representing the community with the healthiest CES score and 100 representing the community with the least healthy CES score. Relative to the HPI, the CES score is interpreted in the opposite direction, with 0 representing communities with the lowest vulnerability and lowest exposure to pollution burden.

Supplemental Figure 4: SVI Demonstrates that Latinos Live in Less Healthy Community
Conditions with Higher Prevalence of Disease. Each point on the scatterplot represents a city within the ten counties investigated in this analysis. The x-axis shows the percentile SVI score, and a higher percentile score indicates a less healthy community. The y-axis shows the percentile score of the prevalence of each health outcome relative to each other (i.e., a percentile score of 100 translates to the city with the highest prevalence of adult obesity or diabetes. Each point (i.e., city) on the scatterplot is colored based on the percent Latino in each city. A red shading indicates a higher percent Latino compared to a purple shading. Panel A shows the relationship between adults with diabetes and SVI score. Panel B shows the relationship between adults with obesity and SVI score. The directionality of the SVI score is opposite to the directionality of the HPI score, where a higher score indicates a greater level of community vulnerability.

Supplemental Figure 5: CES Demonstrates that Latinos Live in Less Healthy Community
Conditions with Higher Prevalence of Disease. Each point on the scatterplot represents a city within the ten counties investigated in this analysis. The x-axis shows the percentile CES score, and a higher percentile score indicates a less healthy community. The y-axis shows the percentile score of the prevalence of each health outcome relative to each other (i.e., a percentile score of 100 translates to the city with the highest prevalence of adult obesity or diabetes). Each point (i.e., city) on the scatterplot is colored based on the percent Latino in each city. A red shading indicates a higher percent Latino compared to a purple shading. Panel A shows the relationship between adults with diabetes and CES score. Panel B shows the relationship between adults with obesity and CES score. Note that the CES score has the opposite directionality as the HPI score. A higher CES score indicates greater vulnerability and greater exposure to pollution burden.

Supplemental Figure 6: Young Latinos Live in Less Healthy Community Conditions and
Face a Greater Burden of Obesity.
Each point on the scatterplot represents a city within the ten counties investigated in this analysis.
The x-axis shows the percentile SVI and CES score, and a higher percentile score indicates a less healthy community. The y-axis shows the percentile score of the prevalence of childhood obesity relative to each other (i.e., a percentile score of 100 translates to the city with the highest prevalence of childhood obesity). Each point (i.e., city) on the scatterplot is colored based on the percent Latino in each city. A red shading indicates a higher percent Latino compared to a purple shading. Panel A shows the relationship between children with obesity and SVI score. Panel B shows the relationship between children with obesity and CES score. Note that the SVI and CES scores have an opposite directionality compared to the HPI score. A higher SVI or CES score